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Apply for Caregiver

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 110 E. St. Peter Street Carencro, La 70520. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 337-295-7990.

Summary
Title:Caregiver
ID:1395
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Additional Information
* How did you hear about Home Instead?
If applicable, please specify:
Applicant Note & Certification
APPLICANT NOTE
Bayou State Home Care, Inc is an independently owned and operated Home Instead® franchise 110 E. St. Peter Street Carencro, La 70520.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION
I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:
CAREGiver v4 Employment Application
BASIC INFORMATION
* Have you ever submitted an application here before?
Yes No
If yes, when?
* Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?
Yes No

WORK HISTORY
MOST RECENT EMPLOYER
* Are you currently working for this employer?
Yes No
* If yes, may we contact?
Yes No
* Company Name:
* City:
* State:
* Company Phone:
* Dates Employed - From:
* Dates Employed - To:
* Duties:
Reason for Leaving:


REFERENCES
If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

Professional References
Full Name Phone Number Best Time of
Day to Call		 Email Relationship (No Relatives) Number of
Years
Known
AM PM
AM PM

Personal References
Full Name Phone Number Best Time of
Day to Call		 Email Relationship (No Relatives) Number of
Years
Known
AM PM
AM PM

APPLICANT NOTE
Bayou State Home Care, Inc is an independently owned and operated Home Instead® franchise 110 E. St. Peter Street Carencro, La 70520.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION
I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:
Caregiving experience
Please explain all caregiving experience you have. Include family members and private clients. In addition, please indicate if your clients had Alzheimer's Disease, Dementia or Hospice care.
* EXPERIENCE:  Include family members and private clients.  In addition, please indicate if your clients had Alzheimer's Disease, Dementia or Hospice care.:
Follow-up questionnaire - background
Follow-up questionnaire – background
As a condition of employment, all employees must be "Bondable".

List states and counties of residence for the past seven (7) years:
County:State:
County:State:
County:State:
County:State:

* Have you had any moving traffic violations?
Yes No
If yes, please describe:
* Have you been convicted of a felony or misdemeanor in the past seven (7) years?
Yes No

If yes, please describe below:
(Conviction will not necessarily disqualify applicant from employment. The recency, severity, and pertinence of the conviction to the job will all be considered.)
Incident City/State Result

Follow-up questionnaire - caregiving experience
Follow-up questionnaire – caregiving experience
Please indicate those tasks in which you have experience. For the areas that you do not have experience, please note if you are willing to learn.

Tasks Experience
Yes/No		 Willing to Learn
Companionship/Conversation
*
Yes No
Meal Preparation (meals/snacks)
*
Yes No
Housekeeping (dust, vacuum, laundry)
*
Yes No
Bathing/showering Assistance
*
Yes No
Dressing Assistance
*
Yes No
Showering Assistance
*
Yes No
Medication Reminders
*
Yes No
Hospice Care
*
Yes No
Stroke Care
*
Yes No
Dementia Care
*
Yes No
Incidental Transportation & Errands
*
Yes No
Incontinence Care
*
Yes No
Personal Care Assistance (Female)
*
Yes No
Personal Care Assistance (Male)
*
Yes No
Alzheimer’s or Dementia Care
*
Yes No
Diabetes Care
*
Yes No
Hearing Impairment
*
Yes No
Transferring Assistance
(Example: helping a person from chair to standing position)
*
Yes No
Ambulation Assistance
(Example: Ensure a person’s stability and safety when moving)
*
Yes No
Mechanical Lift (Hoyer Lift)
*
Yes No


* How many years of experience do you have as a caregiver?

Follow-up questionnaire - work history
Follow-up questionnaire – work history
SECOND MOST RECENT EMPLOYER

Are you currently working for this employer?
Yes No
If yes, may we contact?
Yes No
Company Name:
City:
State:
Company Phone:
Dates Employed - From:
Dates Employed - To:
Job Title:
Supervisor's Name:
Duties:
Reason for Leaving:
THIRD MOST RECENT EMPLOYER

Are you currently working for this employer?
Yes No
If yes, may we contact?
Yes No
Company Name:
City:
State:
Company Phone:
Dates Employed - From:
Dates Employed - To:
Job Title:
Supervisor's Name:
Duties:
Reason for Leaving:


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Lafayette
110 E St Peter St
Carencro, LA 70520
Request Home care for your loved one now
(337) 295-7990
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Each Home Instead franchise office is independently owned and operated.
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